Social Determinants of Symptoms in Preschool Children with Recurrent Wheezing

About This Grant

PROJECT SUMMARY/ABSTRACT Recurrent wheezing in preschool children is highly problematic and results in disproportionate morbidity, with twice the rate of emergency department visits and three times the rate of hospitalization compared to older children. Unfortunately, many preschool children with recurrent wheezing are socially disadvantaged and have significant barriers to wheezing care. Consequently, many disadvantaged preschool children with recurrent wheezing have a high symptom and exacerbation burden that compromises quality of life (QOL). However, there is a paucity of research on symptoms and QOL in this young age group and even fewer studies of disadvantaged preschool children, who remain grossly underrepresented in research yet are at highest risk for poor wheezing outcomes. There remains a critical need to understand how symptoms relate to social determinants of health (SDOH), the biological factors associated with SDOH and QOL, and the factors influencing care. Our central hypothesis is that SDOH promote epigenomic modifications resulting in a sustained state of inflammation, which, in response to a respiratory virus, increases respiratory symptoms and impairs QOL. For this study, we will enroll a heterogenous sample of preschool children with recurrent wheezing aged 12-59 months (N=140) that is enriched for social disadvantage and pursue three specific aims: Aim 1: identify symptom profiles and their associations with SDOH and QOL over 12 months in preschool children with recurrent wheezing; Aim 2: Identify the epigenomic and transcriptional pathways associated with SDOH, symptoms and QOL; and Aim 3: Identify factors related to differential experiences of wheezing symptom management. Through this study, we hope to 1) understand the whole-person experience of recurrent preschool wheezing, 2) identify the social and biological attributes of differing symptom profiles, 3) identify care barriers, and 4) understand moderation by resilience, which could be targeted in future interventional studies aimed at improving QOL in this population. The proposal leverages established and productive scientific collaborations and the state-of-the art scientific infrastructure at Emory University, Children’s Healthcare of Atlanta, and Duke University to strategically investigate health equity and respiratory outcomes for preschool children with recurrent wheezing.